Story and photos by Sarah Annay
First published September 13, 2024 by Grounds for Health
In July 2024, the Grounds for Health clinical team organized a week-long HPV screening campaign in Nyeri County, Kenya with a goal to test 2,000 women.
This was the largest number of test kits used in one week and would critically test our model for scale.
Evah Muendo, our Kenya Program Coordinator, was skeptical at first.
“When we first learnt that we had 2,000 kits to do HPV self sampling in one week, we thought it was a pipe dream. Nonetheless, being the dreamers we are in endless possibilities, we sat down with Patrick, the clinical specialist, brainstormed and planned on how to reach so many women within a short time. We then got the County health department to support the plan and share it with our supported facilities.”
To implement a high-volume campaign with our strong commitment to quality takes a village. We had 12 facilities and hospitals registered to collect the samples, 22 outreach sites where women were mobilized, and facilitation from 30 nurses and 32 community health promoters. Outreach sites in rural areas are strategically placed where women gather—such as churches, pharmacies, coffee farms, tea plantations, health centers, shopping centers and parks.
It is a vast contrast to health systems in high-income countries like the United States, where women’s healthcare is often provided in isolation. In Kenya, cervical cancer prevention is a community-led initiative. Everyone involved in this campaign has an important role, from communication to advocacy to education. Women leave knowing about HPV and cervical cancer and feel empowered to protect their health and their families. They share with young girls in their communities the importance of vaccination.
The ripple effect is seen almost immediately.
Why Self-Sampling?
HPV self-sampling is emerging as a preferred method for cervical cancer prevention in low-resource settings due to its efficacy and effectiveness. In many underserved areas, healthcare infrastructure is limited, and routine screening programs can be challenging to implement.
Self-sampling allows individuals to collect samples in any location – both public and private, including churches, homes and even public markets. This approach increases participation rates, as it eliminates barriers such as transportation, time, and stigma often associated with traditional screening methods.
Moreover, it can significantly improve early detection rates in settings where conventional Pap smear programs are underutilized. The simplicity and reliability of the test empower individuals to take control of their own health, leading to earlier identification of high-risk HPV strains that could develop into cervical cancer.
Challenges
The biggest challenge of screening this many women at scale is the follow-up, particularly for those who test positive for HPV and need to come back for treatment.
The World Health Organization (WHO) highlights the importance of ensuring that individuals who test positive for high-risk HPV strains receive appropriate follow-up care. This includes confirmatory testing and timely treatment, if necessary.
The WHO’s target is to achieve a 70% coverage rate for screening and a 90% treatment rate. This means that 70% of eligible women should be screened with high-quality methods, and 90% of those with positive results should receive effective treatment.
Our Results
As of today, 10 weeks have passed since the week-long campaign and we are well on our way to meeting the WHO targets. Out of 1,813 women tested, 26.1% tested positive and of those positive, 82.2% returned to be screened by visual inspection and 78% of those women were provided treatment.
“I am always amazed by the capacity of community health workers to facilitate mobilization and ensure follow-up for treatment for screening with self-sampling. They are literally the backbone of our ability to meet the WHO standard,” said Dagmawi Iyasu, our Africa Program Manager.
This is a huge milestone and proof that our systems are ready to screen a high volume of women in multiple locations, many times a year.
As follow-up and treatment rates continue to rise with time, our team is proud of what’s been accomplished. There are many lessons learned to share with the global health community and to increase the efficiency of our programs in Ethiopia and Kenya.
Kyle Engelman, who became Executive Director earlier this year reflects on this accomplishment,
“We still have so much to learn about the best model for delivering HPV testing to women around the world – or rather, the best models, since surely we will have to adapt for different geographies, cultures, and contexts. I am so proud of GfH and the Kenya team for their dedicated, insightful, and intelligent work bringing health services to women!”
Sarah Annay is the communications coordinator at Grounds for Health. Sarah is a photographer and educator, with a background in wedding photography and storytelling for nonprofits in India and Nepal. She spent four years teaching annual photography and therapeutic arts workshops to women and girls in Kolkata, India. She has a Masters in International Affairs from The New School, where she applied an academic lens to her arts development work. Her research background is in human rights in the garment industry, global health equity and community-centered design. She looks forward to combining her love for coffee and advocating for women’s health globally, through her work at Grounds for Health.